Provider Demographics
NPI:1245360049
Name:GO, JEANETTE LEON (MED, LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:LEON
Last Name:GO
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 JOHNSTON DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-1815
Mailing Address - Country:US
Mailing Address - Phone:610-317-0118
Mailing Address - Fax:610-317-0119
Practice Address - Street 1:711 W CHEW ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-4027
Practice Address - Country:US
Practice Address - Phone:610-351-2292
Practice Address - Fax:610-351-2293
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003847101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health